Ann RC oll Surg Engl 2009; 91:4 64-469 464Clostridium difficile is an opportunistic, Gram-positive, anaerobic, spore-formingb acillus. Its clinical effects can range from mild self-limiting diarrhoea to life-threatening toxic megacolon and peritonitis. After methicillin-resistant Staphylococcus aureus infection (MRSA), C. difficile is the most wide-spread hospital acquired infection in the UK. In the UK, MRSA infection rates are declining, but rates of C. difficile infection continue to rise. There are several reasons for the increasing incidence of C. difficile infection. One possible reason could be lack of awareness and adequate knowledge among healthcare professionals. There are no studies in the literature that examined the level of healthcare professional's knowledge about C. difficile infection. We,t herefore,c onducted aq uestionnaire-based survey within our hospital to address this issue. Subjects and MethodsAq uestionnaire-based survey was conducted in Weston General Hospital, UK, in January 2007. Eligible participants included doctors, nurses, dieticians, physiotherapists, and theatre staff. Participants were recruited on av oluntary SUBJECTS AND METHODS At otal of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using aq uestionnaire consisting of 17 questions covering various aspects of C. difficile. GENERAL SURGERYRESULTS More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P =0 .001) were aware of the spectrum of illnesses causedb yC. difficile.S even (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6( 33%) consultants, 21 (53%) trainees (P =n ot significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P =0 .05) and 70% of nurses correctly answered that oral metronidazolei st he drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P <0 .0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection.CONCLUSIONS There is as ignificant...

IntroductionThis is the first reported case of perforation and haemorrhage of a Meckel's diverticulum leading to the incidental finding of a gastrointestinal stromal tumour within the diverticulum. Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract, however, when symptomatic, it is often misdiagnosed at presentation. Common complications presenting in adults include bleeding, obstruction, diverticulitis and perforation. Tumours within a Meckel's diverticulum are a rare but recognised complication. We discuss the management of a gastrointestinal tumour within the diverticulum.Case presentationA 59-year-old Caucasian man presented with acute right iliac fossa pain with localized peritonism. At surgery, he was found to have a perforated and haemorrhagic Meckel's diverticulum, associated with a gastrointestinal stromal tumour within the apex of the diverticulum. The absence of necrosis and a low mitotic rate indicated primary resection with subsequent computed tomography surveillance to be the most appropriate management strategy.ConclusionWe report a unique triad of complications associated with the presentation of a Meckel's diverticulum. This article reviews this common congenital abnormality and discusses the management of a gastrointestinal tumour. Meckel's diverticulum will mimic other intra-abdominal pathologies in presentation and should therefore often be considered as a differential diagnosis.

No abstract

No abstract

No abstract